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Personal Information
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*You must enter the date in the format: mm/dd/yyyy
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Parent/Guardian Contact Information
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Last Name: *
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Relationship: *
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College Name:
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Employer:
Parent/Guardian Contact Information
First Name:
Last Name:
Relationship:
Father
Mother
Alternate
Step Mother
Neighbor
Uncle
Sister
Grandfather
Guardian
Aunt
Friend
Step Father
Brother
Grandmother
Coach
Other
Spouse
Parent
Girlfriend
Boyfriend
Child
Guidance Counselor
Wife
Cousin
Husband
Club Director
Step Sister
Step Brother
Athletic Director
Phone:
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College Name:
Occupation:
Employer:
Athletic Information
Height: *
ft.
in.
*Required
Distance 2:
50
100
200
400/500
800/1000
1500/1650
400
500
800
1000
1500
1600
1650
Distance 1:
50
100
200
400/500
800/1000
1500/1650
400
500
800
1000
1500
1600
1650
Stroke 2:
Free
Back
Breast
Fly
IM
Stroke 1:
Free
Back
Breast
Fly
IM
Course 2:
SCM
SCY
LCM
Course 1:
SCM
SCY
LCM
Event 2 Time:
:
:
Event 1 Time:
:
:
Distance 3:
50
100
200
400/500
800/1000
1500/1600
400
500
800
1000
1500
1600
1650
Stroke 3:
Free
Back
Breast
Fly
IM
Course 3:
SCM
SCY
LCM
Event 3 Time:
:
:
Team Coach Information
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Team Information
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OR
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DC
MB
NB
NL
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NT
NU
ON
PE
QC
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UN
YT
PR
VI
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Academic Information
Intended Major:
GPA: *
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1st College Preference:
Grad Year: *
2020
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School Information
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MD
MA
MI
MN
MS
MO
MT
NE
NV
NH
NJ
NM
NY
NC
ND
OH
OK
OR
PA
RI
SC
SD
TN
TX
UT
VT
VA
WA
WV
WI
WY
AB
AE
BC
DC
MB
NB
NL
NS
NT
NU
ON
PE
QC
SK
UN
YT
PR
VI
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School Coach Information
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